Infarct multiple

Everybody suffers some intellectual and memory impairment with age. If it becomes very marked or occurs earlier in life (40+) it is known as dementia. Although it may be caused by alcoholism, cardiovascular disease such as multiple infarcts, and is often seen in the later stages of Parkinsonism, the most common cause is a neurodegenerative one, namely, Alzheimer s disease (AzD). In fact this is the primary and sole cause in over half the cases of dementia and is a contributory cause in a further quarter and the younger the patient, the more likely is the dementia to be of the Alzheimer type. 

The VCG has been used to locate the presence of multiple infarctions. However, this technique is rarely used in daily practice. Furthermore, as we have already stated, it has been demonstrated that practically the same information may be obtained if the ECG-VCG correlation is used to understand ECG morphologies, as is done in this book (Warner et al., 1982). We need to also have in mind that, in some cases of single infarction, Q waves in leads of different areas may be seen, e.g. in an apical infarction due to a distal LAD occlusion, in addition to Q waves in the precordial leads these may also be seen in the inferior wall when the LAD is very long and there is infarction of the inferior wall that may be even greater than the anterior involvement (Figure 5.16). 

Pahlm O, Chaitman B, Rautaharju P, Selvester R, Wagner G. Comparison of the various electrocardiographic scoring codes for estimating anatomically documented sizes of single and multiple infarcts of the left ventricle. Am J Cardiol 1998 81 809. 

Sevilla O, Wagner N, Anderson W et al. Sensitivity of a set of myocardial infarction screening criteria in patients with anatomically documented single and multiple infarcts. Am J Cardiol 1990 66 792-5. 

A 27-year-old male, an alcoholic for 13 years, was treated orally half a year earlier without success. In a new therapeutic attempt 1 g disulfiram was implanted subcutaneously and the patient refrained from drinking. 25 days later he became sick with fever, hypertension and polyneuritis, leading to the diagnosis of periarteritis nodosa, which was confirmed by biopsy. Despite intensive treatment he died one year later. The autopsy revealed the lesions typical of periarteritis nodosa in different stages of evolution, accompanied by multiple infarctions (lungs, spleen, testes) (42 ). 

Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have been shown to improve vascular outcomes due to their cholesterol-lowering effects as well as multiple pleiotropic effects. In high-risk populations, statin therapy is known to reduce the risk of vascular events such as myocardial infarction and stroke. A meta-analysis of 10 trials involving 79,494 subjects showed that statin therapy reduced the incidence of stroke by 18%, major coronary events by 27%, and all-cause mortality by 15%. The SPARCL trial recently showed that high-dose HMG-CoA reductase inhibitors prevent recurrent stroke and transient ischemic attacks. ... 

Patients with massive cerebral infarction may require ICP monitoring, as this may help to guide therapy and predict outcome. Schwab et al. ° evaluated 48 patients with massive hemispheric infarctions and clinical signs of elevated ICP. They found that ICP measurements correlated well with the patient s clinical status, CT findings and outcome, although they did not find a significant effect of their therapies for elevated ICP on patient outcomes. Multiple methods of monitoring ICP are avail-... 

Tohgi, H, Abe, T, Kimura, M, Saheki, M and Takahashi, S (1996) Cerebrospinal fluid acetylcholine and choline in vascular dementia of Binswanger and multiple small infarct types as compared with Alzheimer-type dementia. J. Neural Trans. 103 1211-1220. 

Alzheimer s disease Cerebral infarction Cerebral tumors Closed head injury Cushing s syndrome Hemodialysis Hepatic encephalopathy Huntington s disease Hyperthyroidism Ictal or post-ictal mania Multiple sclerosis Neurosyphilis... 

There have been many sporadic reports that lipo-PGEj is effective in fulminant hepatitis, neuralgia associated with herpes zoster, multiple spinal canal stenosis, cerebral infarction, myocardial infarction, chronic renal failure, and bed sores as well as for its registered indications. 

Peripheral neuropathies maybe widely disseminated or focal. Patients with disseminated polyneuropathy, whether demyelinative or axonal, usually demonstrate distal sensory and/or motor impairment. Multifocal neuropathy, also referred to as mononeuropathy multiplex, is often a consequence of lesions affecting the vasa nervorum, the blood vessels that supply peripheral nerves. The most common diseases to compromise the vasa nervorum and cause infarction of nerve fascicles are diabetes mellitus and periarteritis nodosa. Other frequent causes of mononeuropathy multiplex include infection (e.g. Lyme disease and leprosy) and multiple compression injury (e.g. bilateral carpal tunnel syndrome). When mononeuropathy... 

The levels of G-6-PDH in serum have been investigated in many patients suffering from a multiplicity of disorders (K6), without finding a significant change except in myocardial infarction (K7). In these cases, G-6-PDH activities reach their maxima later than other enzymes reported to increase following this event. The highest values were found about the sixth day after infarction (K6, K7). 

Aging (skin and other tissues), myocardial infarct or stroke, inflammation, rheumatoid arthritis, atherosclerosis, pulmonary disorders (asthma and chronic obstructive pulmonary diseases), radiation injury, organ transplant rejection, psoriasis, hypertension, AIDS, multiple types of cancer, neuro-degenerative diseases (Parkinson s), diabetes, muscular dystrophy... 

Babikian VL, Wolfe N, Lin R, Knoefel JE, Albert ML. (1990). Cognitive changes in patients with multiple cerebral infarcts. Stroke. 21 1013-18. 

Congestive heart failure (CHF) is a clinical syndrome with multiple causes and involve the right or left ventricle or both and in CHF, cardiac output is usually below the normal range. This ventricular dysfunction may be systolic, which leads to inadequate force generation to eject blood normally and diastolic, which leads to inadequate relaxation to permit normal filling. Systolic dysfunction, with decreased cardiac output and significantly reduced ejection fraction is typical of acute heart failure, especially that resulting from myocardial infarction. 

Aspirin (acetylsalicylic acid, Figure 7.9) is a derivative of salicyclic acid, which was first used in 1875 as an antipyretic and antirheumatic. The usual dose for mild pain is 300-600 mg orally. In the treatment of rheumatic diseases, larger doses, 5-8 g daily, are often required. Aspirin is rapidly hydrolysed in the plasma, liver and eiythrocytes to salicylate, which is responsible for some, but not all, of the analgesic activity. Both aspirin and salicylate are excreted in the urine. Excretion is facilitated by alkalinisation of the urine. Metabolism is normally very rapid, but the liver enzymes responsible for metabolism are easily saturated and after multiple doses the terminal half-life may increase from the normal 2-3 h to 10 h. A soluble salt, lysine acetylsalicylic acid, with similar pharmacological properties to aspirin, has been used by parenteral administration for postoperative pain. Aspirin in low doses (80-160 mg daily) is widely used in patients with cardiovascular disease to reduce the incidence of myocardial infarction and strokes. The prophylaxis against thromboembolic disease by low-dose aspirin is due to inhibition of COX-1-generated thromboxane A2 production. Because platelets do not form new enzymes, and COX-1 is irreversibly inhibited by aspirin, inhibition of platelet function lasts for the lifetime of a platelet (8-10 days). 

Other disorders that may kill cholinergic and other neurons, thus leading to memory loss. Vascular dementia, formerly multi-infarct dementia, is characterized by dementia that classically has a more stepwise downhill course as compared with Alzheimer s disease, which has a more smoothly progressive downhill course. Multi-infact dementia is caused by multiple strokes, which damage the brain sufficiently to cause dementia and often cause focal neurological signs and symptoms as well. Normal pressure hydrocephalus can cause dementia from dilated cerebral ventricles. Creutzfeldt-... 

A 48-year-old woman developed avascular necrosis 9 months after she had completed a 3-month course of hydrocortisone 100 mg retention enemas once or twice daily for ulcerative proctitis (470). An MRI scan showed multiple bony infarcts in her distal femora, proximal tibiae, and posterior proximal right fibular head, extending from the diaphysis to the epiphysis, consistent with avascular necrosis. 

Yoshii F, Ooki N, Shinohara Y, Uehara K, Mochimaru F. Multiple cerebral infarctions associated with ovarian hyperstimulation syndrome. Neurology 1999 53(1) 225—7. 

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